A Limited Narrative

Going away :(

Sun, 03 Jun 2007 02:46:08 GMT

Sorry for the recent lack of posts. I've been *thinking about things*.

Before all the boring heavy stuff:

Surgeon comes into theatre, scrubbed, and dons his gloves - latex free, because apparently we're out of "normal" gloves. Scrub nurse comments on his particularly 'green' appearance (what with the gown being green, and the latex-free gloves being green...)
Conversation ensues about the lack of latex-ful gloves, and the reason for being green (apparently it's not as hard as it sounds ;-)
Surgeon: So, are latex-free condoms green, too?
Scrub nurse: Only the apple flavoured ones...

Things you should know -
1. Find out whether your patient who presents for a pap smear has had a hysterectomy before you try to identify the cervix. Most hysterectomies are complete, and remove the cervix too. *That's* why you can't visualise it with a speculum.
2. Post-Herpetic Neuralgia lasts weeks to months to years. It's generally not a good idea to tell the patient this straight out.
3. You won't hear your patient's heartbeat if you haven't clicked your stethoscope on. You might hear a wide variety of ambient noise from the ward, though...

Okay, so now for the gloomy bit.
I've decided to stop blogging.
Although I don't necessarily agree with it, there is a traditional 'cone of silence' mentality that surrounds the medical profession. It's written in the Hippocratic Oath as:
"To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else."

So, when Hippocrates wrote that, he was concerned about 'quacks'. Now, the mentality has shifted a bit, I think, but its the same principle - and this is the bit that concerns me - that people (particularly non-medical people) might lose something in finding that doctors are merely human. My sense of humour here in no way implies that I rejoice in my mistakes, merely that I accept them and will learn from them. And hopefully others will, too.

Whether or not 'patients' (for the purposes of this post, a uniform group comprising all who are not doctors, nurses, etc.) can accept and understand the learning process (and most are incredibly generous with their time and stories), there is benefit to believing their doctors (and medical students) are superhuman.

Sure, these days we talk about 'informed consent', and patients *should* know what's going on, all the time. But to what extent? Do they need to know it's your first time suturing? Do they need to know your success:failure ratio of cannulas, compared to that of nurse A and doctor B?

I guess what frightens me, in this era of pathetic 'current affairs' shows and defensive medicine, is the idea that someone will have had a medical student miss a cannula on them, and sue for pain and suffering, using this blog as evidence. An extreme (and hopefully surreal!) example, but just that *little bit possible* in the current climate.

There are two other 'relative contraindications' to blogging. The first, and most obvious, is patient confidentiality. As you all know, I rarely mention patients at all, and when I do the names, dates and complaints are changed. And none of you know where I study (with a few exceptions).
The second is the first part of the Oath quoted above. My stories of Dr SYS, Dr LaBS, Dr WAFS and Dr NeRA, taken out of context, may seem insulting. Obviously, those who read carefully know of my lasting respect for all of them, and all the wonderful talents they bring to medicine.
So while I've tried to keep this blog all about me (and not about patients or teachers), I think it's too fine a line to judge, especially in such a public domain.

I want to write a book one day, detailing all of my experiences (many of which haven't made it here). In the meantime, I'm emailing friends and family, who know me, and know that I'm well-intentioned and competent. I still never mention identifying details, but I trust those people to know about the requirements of confidentiality.

To those of you who know me in real life - send me an email if you'd like to receive those family and friends emails. To those who don't, I'm really sad to lose touch. If *you* feel safe to 'reveal your true identity' (This is way too much like spiderman...) you can email me at ausmedstudent@hotmail.com, and I'll add you too (this applies mainly to LJ friends and my links list, above - I know from experience that I can trust you! :)

Until then, may all med school bloggers have more intestinal fortitude than me...
AMS

First experience

Tue, 22 May 2007 10:12:58 GMT

I sutured today!! Three stitches in a finger. Blood everywhere. But it was *great* (I also missed 4 cannulas...!!!! In nursing staff. Only one in a patient.)

I spent the day with Dr NeRA today. Because of the nature of his work, he has lots of regular (ie weekly) patients, who he's known since childhood. He's great with people of all ages, and the patients are very comfortable with him.

[An aside: as in this blog, in real life I call all my supervisors by their title and surname. I think it's respectful, and I think it reinforces the dynamics of the teacher-student relationship. I also call patients by their title and surname, unless they're under 25ish, or they invite me.]

One of his regulars came in with her new boyfriend, for a scheduled checkup. Dr NeRA (who, remember, is Nearing Retirement Age), was greeted with "Nezzzzzaaaaa!", Which I thought was *fantastic*. Cracked me up.

One of my previous supervisors approved of my title-surname approach to patients. Had I not been doing it already, he probably would have advised me to. An elderly inpatient of relatively long standing - we'll call her Betty Howard - was a beautiful old lady, who greeted me every morning with "Good Morning, Ausmedstudent." Every morning, I'd reply with "Good morning, Mrs Howard" - and she'd say "Call me Betty."

After the third day she'd said that, I began to greet her with "Good morning, Betty." Now, during this period, Betty's doctor (my supervisor) had been on leave. On his return, here was an insolent medical student calling a lovely elderly lady by her first name! Luckily, it became apparent to him that we were on first name terms.

I must have seen 250 patients since then, and fewer than 10 have invited me to address them by their first name. I like it that way :)

Starlight, Starbright.

Fri, 18 May 2007 11:19:24 GMT

I've had a good few days. One of my long-term inpatients from my last rotation told me he'd noticed my confidence growing of late, which makes me happy :-) (He's the same one who wolf-whistled a while ago).

There have been a few problems in the university's organisation of my rotation - hence I spent yesterday in theatre (not due til next rotation) and today in the dementia clinic. I saw a couple of Caesars, then started to feel a bit queasy. I had to leave, and I'm ashamed to say the doctors present probably thought I wasn't up to the 'gore' of theatres. I was just sick - went home and slept for four hours. For all those wondering, I'm also not pregnant (unless anyone's seen a new star in the East)

Today was great, too. The geriatrician spent a great deal of time with each patient, which is refreshing after ED! It's also very necessary, to get the full story on each patient. On the way out, late tonight, I saw the first star, and stopped in my tracks...

"Starlight, Starbright, first star I see tonight. Wish I may, wish I might, have the wish I wish tonight." I may or may not have subsequently mentioned cannulas.

GAMSAT results

Thu, 17 May 2007 07:40:27 GMT

Results are out for another year - hope everything went as planned for everyone, and that tonight is one of celebration!

To all/most of my link list - I can't comment on your blogs atm, because blogger doesn't like my passwords. But I still care :)

8 Random Things About Me

Wed, 16 May 2007 11:09:50 GMT

I was tagged by M&2S - I hereby tag who_wraith and crazedturkey and magicaldots.

1. I can sign in Australian Sign Language and fingerspell in American Sign Language.
2. I have a first-cousin-twice-removed on the way. My cousin's about to become a grandparent, and I don't even have kids yet!
3. I have a huge thing for two English food products: Jaffa Cakes and Alpen Muesli. Every time anyone goes over there I bribe them to bring those things home.

4. I can't drink water from the same glass twice, and I generate inordinate volumes of washing up as a result. This isn't some bizarre obsessive trait, but an apparent blindness to glasses I've left next to the sink previously.

5. I have a completely irrational fear of dentists. And mice

6. I love to sing, and was in a musical in high school. My ultimate goal with singing would be to perform in Les Miserables (Which will never happen).

7. I'm allergic to bananas. The last time I ate one was the morning of GAMSAT, thinking it would give me the extra brain power I'd need. It gave me a swollen tongue, and hives.

8. I have a cat called Monty, who we 'borrowed' from our neighbours. The neighbours moved away, and we still have Monty.

A lasting legacy

Wed, 16 May 2007 02:59:41 GMT

On Monday, we had a lunchtime tutorial on continence. Three volunteers were asked to present a case for our tutor - Dr SYS. Unfortunately, two people were absent, so there was a total of four of us in the tute. I, of course, hadn't volunteered. I also spoke *not a single word* during the tutorial. This behaviour may have precipitated the following event...

Dr SYS said to one of the nurses today -

"Ausmedstudent's still scared of me. I've been trying! I'm not scary, am I?"

RN: "You're not scary, you're just not very approachable...."

(This conversation was, of course, relayed to me via said RN...)

This is after a conversation with ANE (of nearly-needlestick fame) last night. She asked me who was the best teacher of my previous rotation. My answer was, of course, Dr SYS. ANE had thought Dr LaBS would have been the best teacher. I have to say, Dr NeRA's doing a great job, too.

When I look back, it's probably not that Dr. SYS is overly scary - more that he was my first supervisor on a clinical rotation, and I was his first student. It's a awkward path to forge together. I almost wish I'd had a different rotation first, because now I'm much more capable of dazzling people with my brilliance... and could probably derive more benefit.

ED - but (almost) no Dr. SYS!

Tue, 15 May 2007 12:16:18 GMT

So, today was supposed to be my day in ED with Dr. SYS. Unfortunately, he remains unwell, so he wasn't put on as 'first', and seconds (and thirds, etc.) can't have students. Fortunately, Dr. Bean was rostered on first and had temporarily misplaced his student (I didn't ask) so I spent the day with him.

Dr. SYS did ask me to examine a lady with a large pleural effusion, which I did while he'd stepped out of the department for a moment. I tried to elicit the common signs - namely, dullness to percussion and absent breath sounds. I also listened for changes in vocal resonance and vocal fremitus.

Subsequently, I went back to seeing outpatients in a consult room. Dr. SYS came in to get something - and asked me whether I'd elicited the signs I'd mentioned above. Apparently, he can still grill me when not only am I not his student, but I'm not even his student-in-ED-for-the-day! On the upside, for once I had done all I'd been expected to.

I left at about 6.30 to have dinner with a friend, about 7km away from the hospital. JD is also a medical student, so we were 'debriefing' on our respective days. She mentioned something about an AAA - an abdominal aortic aneurysm - and the thought struck me that I'd felt a very pulsatile abdominal aorta in an elderly man presenting with epigastric pain, and failed to check with Dr. Bean or to document it.

So, straight after dinner, I drove back to the hospital (the opposite direction to my house) to mention it. Dr. Bean re-examined the patient, and it turns out it was all in my head. I think this obsession with AAAs is largely attributable to Dr SYS - one of his favourite 'surgical sieves' is "What Must I Not Miss?", a phrase he repeats during every patient discussion. And his favourite example is the AAA in epigastric pain.

I have a(nother) headache :( Tomorrow, I'll be in ED again, this time with Dr NeRA. If I'm to feign intelligence for another whole day, I shall have to be off to bed.

Dr. NeRA.

Mon, 14 May 2007 09:38:50 GMT

So, Dr. NeRA is my new supervisor. He's *so* laid back, he puts Dr. LaBS to shame. He asks third-year-appropriate questions, and gets me to see third-year-appropriate patients. I'm so well adjusted in his presence it amazes me!

I saw a patient today who wanted to start the oral contraception pill. It was so fantastic to be able to discuss something I knew something about! And, when I presented the case, it was a relatively short and succinct one - and my patient (and her mother) applauded!

So, in case we needed further proof that my Dr.-SYS-phobia was all in my head, I've been calm and relaxed all day, even when I stuffed up. Or perhaps I'm more familiar with stuff ups. And Dr. NeRA has had students for many more years than Dr. SYS, for whom I was his first ~~victim~~ student.

Tomorrow is another ED day with Dr. SYS, so we shall see how I go! I think I've grown up over the weekend... :-)

Out with the old...

Mon, 14 May 2007 04:10:45 GMT

Well, as some of you have noticed, I've changed my blog layout and stuff. I think it looks all grown up :)

I also decided my blog needed a more abstract title, and I got this one from a book of essays I'm reading at the moment. It's by Peter Goldsworthy, who's an author and a GP, and who wrote Maestro, one of my favourite books of all time. In his essay, he talks about the central character of Maestro being a 'limited narrator'. I've provided the link in the previous entry. Obviously the term is one from literature generally, and not peculiar to him.

Speaking of ''in with the new", it's my first day of a new rotation. The next six weeks consist of drugs and alcohol and psych, and more ED. My new primary supervisor is Dr. NeRA - Nearing Retirement Age. (Aside: his naming as such is not a value judgement; it's merely that his impending retirement is his favourite topic of conversation...)

Also featuring:
Dr. YAM, who's Young and practises Alternative Medicine
and the perennial favourite, Dr. SYS.

I'm still in the same clinical school, so Drs. LABS, WAFS, and Bean may still make the odd appearance! :) I have a splitting headache, so I'm off to bribe the nurses for a panadol or two.

Eduard Keller and Dr. SYS

Fri, 11 May 2007 12:11:09 GMT

Who is Eduard Keller? And what does he have in common with Dr. SYS?

A "Limited Narrator".

Fri, 11 May 2007 09:33:38 GMT

Today was interesting. I spent the day with Dr. LABS in ED. I saw viral hepatitis, a torn medial collateral ligament in the knee, a boil (which we lanced), and a few not-very-sick people. There were also two people who presented for one problem, and actually wanted treatment for their anxiety disorder. They were obviously anxious, and obviously needed treatment, but it's just not possible to provide continuity of care for patients on an outpatient ED basis.

The nursing staff are helping me through my not infrequent crises of confidence. They're really supportive (although there's a vast majority of them who hate Dr. SYS) and talk me up out of all proportion!

I also had a new experience, twice, today. I had to see a patient I knew socially (twice). Both are acquaintances - one was malingering, the other was terminally ill. It was all a bit difficult, to be honest. There's a need to balance the wishes and beliefs of the patient with your clinical judgement. And it's quite distracting, especially as both of them were in a position of superiority when I knew them.

In other news, I've just seen on the ABC that 300mg of aspirin daily may reduce risk of bowel cancer. Nearly fell off my chair laughing when that made the news. Wish it had been 325g, but it's much closer to my dose than 100mg!

The final foot-in-mouth syndrome

Thu, 10 May 2007 11:45:04 GMT

I forgot to mention something else I did today, which is markedly less cool.

Part of our assessment this year relies on satisfactory completion of set tasks for our supervisors. We need to complete at least 4 comprehensive medication reviews in third year, at least one each from internal medicine, surgery and general practice patients.

I recently completed a medication review on one of Dr. SYS' patients (because he'd told me to go and see her, and I couldn't get a good history, I didn't present it as a case, but I was trying to show willing by taking advantage of his patient).

Of course, Mr. M. was on a thousand medications, including complicated ones for glaucoma. He was also on aspirin. For each medication, I studiously researched class, mode of action, advantages and disadvantages of the class and specific drug, evidence for use, cost, convenience, interactions, adverse events, etc. Took me hours.

In order to format all this information, I'd bolded different bits to make them easier to spot. I thought I'd unbolded them before submission. Apparently not. The one passage I'd left bold was:

"There is no good evidence to support a dose of 100mg of aspirin to prevent thromboembolism in patients with AF. A dose of 325mg is better supported".

This was one of very few criticisms I'd made, and I'd gone and bolded it, then handed it to Mr. M's treating doctor! He said this evening, when he'd marked my work and handed it back, that he'd 'taken my comments on aspirin doses on board'. It must have looked like it was deliberate! I explained, but I decided I was better off if I stopped digging. In my defence, I said from the outset that he only had to sign that I'd done it, not that he'd read it, but still...

Just as well the wine was expensive!

So how did I go?

Thu, 10 May 2007 08:40:11 GMT

Good day today.

Dr. SYS is sick at the moment. Still at work (wearing one of those oh-so-flattering surgical masks to prevent contagion), and quite dysphonic. In combination, this made him difficult to understand - inaudible speech plus no clues from lipreading!

On the upside, I saw a patient for him and did my best (short) long case ever. I saw her, took 5 minutes to compose my thoughts, then (other than the sympathetic activation) presented the case quite well.

I was actually supposed to be with Dr. LABS today - I admitted a patient for him, taking a particularly poor history, but writing up a beautiful (generic) med chart. Then I got a phone call because the pharmacy was out of a certain strength of the drug.

Now, because I found him first, and neither doctor knew this patient, Dr. SYS checked and signed my medication chart (I'd copied it out from a photocopy, changing brand names to generic names). So, I had to ask him whether the patient could have 25mg instead of 20mg. Then, seeing as she was officially Dr. LABS' patient, I told him, then a got another phone call saying there were 10mg tablets... Then Dr LABS went to see the patient (Which Dr. SYS had been planning to do, to make sure everything was okay), so I had to go and see Dr. SYS to let him know everything was okay, and he could go home to some chicken soup.

I'd left wine and aforementioned letters in the various lunch rooms earlier this morning, so that the Drs LABS, WAFS and SYS would find them and not have to see me at the same time (told you I'm a non-confrontational wimp).

When I saw Dr. SYS, he was thrilled not to have to admit the patient, and then proceeded to complement me on my case presentation today. Then, he thanked me for the wine and said I was too generous (they were $70 bottles - Dad gave them to me to give to them). I was a *grown-up* and accepted his thanks, and reiterated my gratitude for his help.

*Then*, he offered to supervise me on a few other days when I'm around and he's rostered as first in emergency. *And*, he'll keep an eye out for interesting patients on his ward for me.

Yay! Good day today. And, of course, it means Dr. SYS will be on the scene here for another few weeks (for drscruffy, who was going to miss him :)

In other news, today I learnt (from isilya!) that the contraction of doctor is 'Dr' and not 'Dr.', ie that there is no full stop. Having learnt that, I should be typing that. But I'm not, yet - old habits die hard.

So, what do you think?

Wed, 09 May 2007 12:49:17 GMT

Dear Dr. SYS,
Thank you for the time and effort you've taken to teach me over the past few months.
You've motivated me to set a high standard for myself, and I've learnt a lot.
A small token of my appreciation - Cheers!
Ausmedstudent.

Dear Dr. LABS,
A small token of my appreciation of your teaching over the past few months.
I appreciate the effort everyone's put in, and I've learnt a lot.
Cheers
Ausmedstudent

(Both go with a nice bottle of wine)
Too crawling? Too long? Too misinterpretable? Any suggestions? Need input ASAP... please help!

Warm and fuzzy

Mon, 07 May 2007 02:02:43 GMT

There is but a week remaining of my placements with Drs. SYS, LABS and WAFS. I've learnt heaps from these doctors. I'm a little bit sad about moving on (especially in light of Dr. SYS' new leaf).

Today, I walked in and Dr. SYS greeted me with a big smile and 'How are you, ausmedstudent?' He asked me to see a patient with ALS.

I sat down with an older lady who proceeded, for the first 5 minutes of our interview, to tell me how *wonderful* Dr. SYS is. She told me about her late husband, and about how when he died Dr. SYS sat with her and held her hand. She remembers him for that three years after the event.

I know we're always supposed to listen to patients, but those of you who've taken histories from older, bored inpatients will know that you listen for key points, and tend to ignore the discussion of the health problems of the great-niece of the patient's bridge partner.

Today, I had nothing to do, so I was happy to talk to Mrs. L. I listened properly, a 'chat' rather than a history (given that I had a few hours...) and I was so moved by Mrs. L's gratitude to Dr. SYS that I had tears in my eyes.

My mum had a saying: "Is it true, is it nice, is it necessary.' We were supposed to think all of those things before we said something about someone. With blogging, there's an unspoken addendum: 'is it identifiable'. When I blog, I try to blog so that Dr. SYS (or Dr. LABS, Dr. WAFS, any of the nurses or any of the patients) would not be upset by reading it. With patients, this isn't a problem - there's no chance they'd recognise themselves from my descriptors. There's very little chance that anyone would recognise me, unless they worked with me. Those whose conversations I have reproduced may recognise themselves.

I hope that if Dr. SYS did stumble on this blog, he would think it a fair representation of our relationship. I try to make it clear that it is my inadequacies that make me laugh/cry, and not anything that he's done. And, as I require praise occasionally, I post things like Mrs. L's experience to redress the 'scary' balance.

Chances are, though, that Dr. SYS will never stumble upon this blog. So, along with Drs. LABS and WAFS, I've bought Dr. SYS a nice bottle of wine, to thank him for his help for the last 12 weeks. I aspire to write a letter expressing my gratitude, whilst avoiding the 'Dear Dr. SYS. Thankyou for your help over the last 12 weeks. Regards, ausmedstudent' trap.

In the past, I have very much enjoyed writing personalised thankyous to people who have helped me. I try to include an 'injoke', or similar, so that the recipient knows that it was written for them. For people with whom I have failed to establish a rapport, the letters tend to be more formal (although still handwritten).

With Dr. SYS, I'm facing a problem. There are many injokes (as you've all read), but I'm not sure whether or not the rapport is sufficiently established for a less formal thankyou. I guess this week will tell!

Any advice gratefully received...

Long time no post.

Sun, 06 May 2007 01:29:50 GMT

Sorry about the dearth of posts. It seems I need the encouragement of comments, and with

who_wraith being away...

Well, the time has come to rectify said dearth, and given that it's Sunday (day of rest for some, day of housework for others) it's as good a time as any. Especially as my clothesline has coalesced into one giant spiderweb, a huge disincentive to housework.

High points of this week - the weather has been fantastic. I was walking down to the shops from the hospital, and one of my (70-year-old) patients was on day leave. He and his wife were driving along, saw me, wound down the window and wolf-whistled at me. It was so lovely :) I also delivered a brilliant presentation at our surgical tutorial, and passed really well.

I also found an ironing lady. She's not that brilliant, but she's definately better than me. The saga of my hatred of ironing has become so well known, that when I arrived (ironed) on Tuesday, everyone said how 'smooth' I looked :)

This week was also the first time I've seen scarlet fever, which I diagnosed myself, and the first time I've felt subcutaneous emphysema.

I know terranik and who_wraith and magical dots, are all waiting for gamsat results. Good luck and let me know how you go! :)

Flash(back) of brilliance!

Mon, 30 Apr 2007 11:59:05 GMT

In the spirit of recounting triumphs as well as failures (a tradition that's likely to continue at least as long as Dr. SYS maintains his current warm and fuzziness)...

Today I did some venesection for a patient with haemachromatosis. This involves sticking an *exceptionally large needle* into a vein and leaving it there for 5 minutes while the patient bleeds into a bag. I got the vein!!! First go!!!

And, when Dr. SYS returned, he asked me how I went (all cheerleader-style - a questioning look and a thumbs up)

Ausmedstudent: "I got it!! First go!!"

Dr. SYS: "Well Done!"

I turned to wash my hands and had to hide my smile from Dr. SYS (I'd hate him to think I craved his approval, after all...:-)

I want to be (the newly bright-and-shiny) Dr. SYS when I grow up...

Sun, 29 Apr 2007 00:01:46 GMT

Ooh, I just got my first comment spam. I must be moving up in the world :)

The other day, (pre new-leaf), Dr. SYS asked me to see a patient in room 108. This room has 4 beds, but is a semi-specialist ward, so it generally has males and females together.

There are about 8 doctors who can admit patients to this particular room. So, when Dr. SYS said he wanted me to see a female patient of Dr. M's, I figured she'd be easy to spot. Rather that overload my brain with her whole name, I remembered that her first and surname started with the same letter, and figured that with all that info, I'd be sure to spot her.

I walked into 108. All the patients were female. 3 were patients of Dr. M. Their names?

Sally Smith
Jenny Jones
Betty Brown

(well, not really, obviously, but you get my drift...)

Luckily, only one of them had seen Dr. SYS in emergency...

Fri, 27 Apr 2007 10:31:57 GMT

Sorry about the last post being so bizarrely formatted. Everything went bold by itself, and I couldn't link to anyone. It took me four goes to even get it looking that good.

Well, we'll start with the good news: Dr. SYS has (apparently) turned over a new leaf. He was all sweetness and light today. Unfortunately my autonomic nervous system has yet to comprehend the change... Even with constant reassurance, I blushed with the horror of having to present cases. The vasodilation was so longstanding that one of the receptionists made a joke about me teething!

I visited the nurses' station on the way home, and a couple asked how the blood taking was going. I admitted to another missed vein, so I practised again on one repeat victim, and on a brave EN. They're so nice - they even pretend it doesn't hurt. Dr. SYS (who is never at that particular nurses' station, especially not at that time of day) arrived and asked what I was doing (I was still wearing gloves, and had a kidney dish and a tourniquet in my hand - I didn't think I could get away with saying 'plastering'...)

He was even supportive of that! And his parting words were 'Take care of yourself, Ausmedstudent'. Presumably someone has told him I cried.

The less-good news: Yesterday, I decided to hang around with a different doctor in ED. He really enjoys having students, but only for very short stays. Dr. SYS once said that this particular doctor reminded him of Mr. Bean (must have been one of his disinhibited moments!), so this doctor will now be referred to as Dr. Bean.

Anyway, Dr. Bean and an RN were having a cup of tea when I approached to find out the timing of an autopsy I was supposed to be seeing. Dr. WAFS was also going to assist.

Ausmedstudent: "What time is Dr. WAFS' autopsy today?"
RN: "What?!?!"

RN had been away three days and thought Dr. WAFS had died. He's not that old. Standard ausmedstudent foot-in-mouth syndrome...

Bizarrely, the next patient I was going to see had the surname "Killer".

Top 5 reasons I blog

Thu, 26 Apr 2007 11:36:26 GMT

1. To demystify the study of medicine - After reading the paging dr forum, I realised I was not the only one who had obsessively sought information about medical school. When I asked current medical students, they didn't seem to want to say much about the medical school experience. I thought they were snobs. Now I think it's really easy to forget what a privilege it is to study medicine. I enjoy sharing it with others, somehow easing the burden of waiting for GAMSAT results for some, I hope!

2. To remember my journey - All these new experiences! When I look back, I've had some fantastic experiences which I scarcely remember! I guess it's unreasonable to hope to remember everything when I'm trying to learn so much, but this is an excellent reminder. It helps me see how far I've come.

3.As a creative outlet - Writing gives me an opportunity to organise my thoughts in a creative way. I enjoy writing academic stuff, but creative writing allows me to waffle at length! It's also helped me to write more clearly - I tend to think faster than I type, so sometimes I over-summarise. Creative writing helps me not to miss a step when I'm writing academic stuff.

4. As a coping mechanism - this is a recent benefit I've noticed from blogging. Clinical times are stressful, and laughing at my experiences gives me perspective. The wonderful support I get from comments makes everything that little bit easier, too!

5. To crusade for appropriate punctuation in the public domain - Okay, so it's a little bit pedantic. I'm passionate about punctuation - especially apostrophes - and I think it's really important that we maintain high quality writing, even in informal media.

Thanks to M&2S for tagging me. I tag crazedturkey, audaci, isilya, terranik and who_wraith. I'd link to you, but lj is trying to kill me.

Sense of humour...

Wed, 25 Apr 2007 09:39:10 GMT

A patient asked Dr. WAFS whether it was safe to have a cortisone injection in her knee.

A nurse joked 'Everything we do here is dangerous.'

To which Dr. WAFS replied: "It's okay, I have a mortuary out the back..."

Ausmedstudent looks shocked, before dissolving into laughter when the patient does.

Update

Tue, 24 Apr 2007 10:27:50 GMT

So, having expressed my fears about a bloodtaking drought... four of the nursing staff let me take blood/attempt to cannulate them!

I took blood from a man with hosepipe veins (successfully), then unsuccessfully attempted to cannulate someone, then successfully cannulated someone, then unsuccessfully cannulated someone (twice!)

Thank goodness for nurses who have sympathy for blood-taking bad patches.

The successful cannulation resulted in carnage appropriate to the scene of a mass murder than to a volunteering scenario (Blood. Everywhere.) And the final cannulation (in the hand, having missed the snuffbox) I blew a fantastic vein... Leaving HaF nurse with a massive bruise on the back of her hand for weeks to come.

On the upside, I'm feeling better (a bit) about cannulation and blood taking...

Another enforced lunch break :)

Tue, 24 Apr 2007 04:59:18 GMT

Over the break, I went retail-therapying to buy 'confidence clothes'. (I tried on a few 'confidence thought patterns', but they didn't fit... :)

So today, I am wearing my new confidence clothes. Complete with shoes with a too-high heel, which are hurting my feet.

Unfortunately, they seem to have powers other than confidence-induction. Today, I have been completely unable to take blood, even from people with drainpipe veins. I missed a cannula first, then two bloods on the same person, then another blood on someone I was using a butterfly needle on!! By this stage, I was having a complete crisis of confidence, so I decided it was in my best interests to photocopy, instead.

I broke the photocopier.

Then I went to the clinical school and drowned my sorrows with home-baked auxillary lady biscuits, which is where I remain.

Into the fold, dear friends - I must get a vein today, or I will have a complex forever.

Mon, 23 Apr 2007 06:56:58 GMT

This is really important to me, so rather than tell you about the rest of my day, I'd like to direct everyone's attention to this page:

Truth in advertising for pregnancy counselling services

I'm not going to say where I stand on the issue of abortion, because I fully respect your opinion, whatever it may be. But I think it's only fair that a woman in crisis, be she of my belief system, yours, or any other, should know what point of view her 'pregnancy counsellor' is coming from.

Lunch breaks

Mon, 23 Apr 2007 03:48:46 GMT

Last week, the uni passed a new 'law' of clinical placements: "Thou Shalt Have Lunch".

This is designed partly for our sanity, but predominantly for the sanity of doctors, who complain that medical students slow them down.

So, here I am, on my lunch break, with very little to do (I could go across to the kiosk and buy myself a hot chocolate and a red frog, but that would be both expensive and unhealthy, so I shall sit on my laptop in the clinical school instead!)

More on flashes of brilliance: Yesterday, I had a game of pitch'n'putt (golf) with my dad - I am notoriously crappy at pitch and putt. Dad has played golf for much of his adult life. We were *even* after four holes! Obviously, he pulled ahead eventually... but I was hitting pretty well, so that the ball went up (rather than running along the ground) when I hit it. Amazing.

Unfortunately, I have the attention span of an insect, so by the back nine I was back to my normal, sucky-at-pitch'n'putt self.

Now - to the medical. In the Emergency Department (ED, A&E, casualty, whatever you want to call it) patients see a triage nurse first, who gives them a number based on how urgently they need to be seen. Most people get a 4 - people with colds, sore throats, headaches of several weeks' duration, nausea, sunburn, lacerations that aren't haemorrhaging... whatever. People who've come to ED to get a prescription get a 5. Chest pains get a 2 or 3, and are seen pretty much straight away. I've never seen anyone triaged as a 1, but I guess that's reserved for people in cardiac arrest!

[Aside: the nurses in our ED do so much more than triage - a patient is seen for a short history, vital signs are taken, and if it's chest pain or similar, patients are put into a bed, an ECG taken, oxygen started and the patient attached to a monitor, so that the doctor has full info straight away. If it's nausea, there'll be a urine specimen taken and tested with a dipstick - and if they're female between 12 and 50, a pregnancy test, too.]

In the Emergency Department with Dr. SYS today, we had 4s & 5s until about 12.30. Then, an ambulance brought in a 10-month-old girl, who'd just eaten a tiny bit of crabmeat from her mother's plate. Her mum called the ambulance about 20 seconds later, when the poor kid's throat, face, and feet started to swell.

The ambulance rang ahead to warn us, so we raced around to get the resuscitation room ready for a paediatric case (guess who doesn't know where the endotracheal tubes are kept? :). Luckily, when they arrived, bub was still breathing, so we just gave her adrenaline and watched her recover. Then gave her an antihistamine, and put her on a monitor for an overnight stay, poor thing. Imagine what it must be like to be the parent! I was amazed at the speedy recovery, though. It's nice to feel like there's something that can be done.

I also watched Dr. SYS take an inordinate amount of fluid from someone's knee with a big needle this morning. Another speedy recovery for the patient!

Well, just enough time to sneak in a red frog before I get back to work. The kiosk ladies (volunteers from the hospital auxillary) tell me Dr. SYS likes cherry ripe - might have to bring one back to him, as he won't have had lunch. Although that might be seen as crawling...